A Systems Approach to Front-End Redesign With Rapid Triage Implementation.
Nicholas Alen Chmielewski, Theresa Tomkin, Gara Edelstein
PMID 33952880WHAT IT FOUND
Standardizing triage across six emergency departments significantly reduced door-to-triage and door-to-provider times for the whole system.
However, results varied by site, with no improvement at one department and mixed outcomes at others.
Key findings
01The system-wide project achieved statistically significant improvements in door-to-triage time, door-to-provider time, and length of stay for discharged patients.
02One site (ED1) showed no significant improvements, and overall emergency department length of stay significantly increased in all groups at that site.
03Three sites (ED3, ED5, ED6) saw significant reductions in length of stay for discharged patients, while ED3 and ED5 also had significantly reduced door-to-provider times.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study took place in a single health system, so the results may not apply to other organizations. Many other concurrent improvement initiatives were happening at the same time, making it difficult to isolate the effect of the triage redesign alone. Length of stay metrics are heavily influenced by external factors like inpatient bed availability and staffing, which were not controlled for. The project did not meet the definition of research, so it lacks the rigor of a controlled trial.
Declared interests
The authors report no conflicts of interest.
The easy way to misread this
Do not assume that implementing rapid triage will automatically reduce length of stay or improve all metrics at every site. One department saw no improvement and increased length of stay, and the authors note that external factors like bed availability heavily influence these outcomes.